Risk factors for Epstein–Barr virus reactivation after renal transplantation: Results of a large,multi-centre study

Epstein–Barr virus (EBV) reactivation is a very common and potentially lethal complication of renal transplantation. However, its risk factors and effects on transplant outcome are not well known. Here, we have analysed a large, multi-centre cohort (N = 512) in which 18.4% of the patients experienced EBV reactivation during the first post-transplant year. The patients were characterized pre-transplant and two weeks post-transplant by a multi-level biomarker panel. EBV reactivation was episodic for most patients, only 12 patients showed prolonged viraemia for over four months. Pre-transplant EBV shedding and male sex were associated with significantly increased incidence of post-transplant EBV reactivation. Importantly, we also identified a significant association of post-transplant EBV with acute rejection and with decreased haemoglobin levels. No further severe complications associated with EBV, either episodic or chronic, could be detected. Our data suggest that despite relatively frequent EBV reactivation, it had no association with serious complications during the first post-transplantation year. EBV shedding prior to transplantation could be employed as biomarkers for personalized immunosuppressive therapy. In summary, our results support the employed immunosuppressive regimes as relatively safe with regard to EBV. However, long-term studies are paramount to support these conclusions.     

Cytogenetic studies of preinvasive lesions and invasive carcinomas' of the cervix uteri. III. Survey and interpretation of the results reported in the literature.

Summary. Cytogenetic studies were performed of 54 preinvasive carcinomas and invasive squamous cervix carcinomas altogether. The chromosome number could be determined in 9 dysplasias, 25 carcinomas in situ, 4 carcinomas in situ with micro-invasion and 16 invasive squamous carcinomas (at least clinical stage Ib). It was shown that carcinomas in situ, carcinomas in situ with microinvasion and invasive squamous carcinomas could not be differentiated from each other in principle as groups with regard to numerical chromosome deviations...     

Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence,transfusion requirements,and outcome

OBJECTIVE: To determine prevalence, risk factors, and outcome of thrombocytopenia in medical intensive care patients. DESIGN: Prospective observational study. SETTING: The 12-bed medical intensive care unit of a university hospital. PATIENTS: All consecutively admitted patients with normal platelet count at admission and an intensive care unit stay of >48 hrs during a 13-month period (n = 145). MEASUREMENTS AND MAIN RESULTS: The prevalence of intensive care unit-acquired thrombocytopenia (platelet count, <150.0/nL) was 64 of 145 patients (44%). Intensive care unit mortality was 31% in thrombocytopenic patients and 16% in nonthrombocytopenic patients (p =.03). Mortality was higher in patients with a nadir platelet count of <100.0/nL (p <.001) and in patients with a drop in platelet count of >/=30% (p <.001). In nonsurvivors, the decrease in platelet count was greater (p <.001), the nadir platelet count lower (p <.001), and the duration of thrombocytopenia longer (p =.008) than in survivors. A logistic regression analysis identified septic shock (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.40-9.52), a higher Acute Physiology and Chronic Health Evaluation II Score at admission (OR, 1.06 for 1 point; 95% CI, 1.01-1.12), and a drop in platelet count exceeding 30% (OR, 3.73; 95% CI, 1.24-11.21), but not thrombocytopenia, as independent risk factors for intensive care unit death. Correction of thrombocytopenia was associated with reduced mortality (OR, 0.002; 95% CI, 0-0.08). Major bleeding prevalence and transfusion requirements were significantly higher with thrombocytopenia. Nadir platelet count was the only independent risk factor for bleeding (OR, 4.1 for every 100.0/nL; 95% CI, 1.9-8.8). Independently associated with thrombocytopenia were disseminated intravascular coagulation (OR, 14.94; 95% CI, 3.92-57.00), cardiopulmonary resuscitation as an admission category (OR, 5.17; 95% CI, 1.42-18.85), and a higher Sequential Organ Failure Assessment score (OR, 1.20 for a 1 point change; 95% CI, 1.02-1.40). CONCLUSIONS: Thrombocytopenia is common in medical intensive care unit patients. Thrombocytopenic patients have a higher prevalence of bleeding and greater transfusion requirements. A drop in platelet counts of > or = 30%, but not thrombocytopenia per se, is independently associated with intensive care unit death. Serial measurements of platelet counts are important and readily available markers for monitoring the patient's condition. Any drop in platelet count requires urgent clarification. Disseminated intravascular coagulation, signs of organ failure at admission, and cardiopulmonary resuscitation are predictors of intensive care unit-acquired thrombocytopenia.     

Faecal Elastase-1: Lyophilization of Stool Samples Prevents False Low Results in Diarrhoea

Background: In patients with diarrhoea, faecal elastase-1 is used to detect exocrine pancreatic insufficiency. Diarrhoea is defined as &gt;85% stool water content. Methods: We analysed elastase-1 in 519 stool samples from 310 patients unprocessed as well as after lyophilization in a standard laboratory lyophilizator. Stool water content was calculated by weight difference before and after lyophilization. Results:     

Changes in quality of life after medical intensive care

OBJECTIVES: To determine outcome and changes in health-related quality of life (QOL) in medical intensive care patients. DESIGN AND SETTING: Prospective comparison of QOL before and 6 months after intensive care unit (ICU) admission in a 12-bed noncoronary medical ICU of a university hospital. PATIENTS: All 325 consecutively admitted adult patients who spent at least 24 h on the ICU were eligible. MEASUREMENTS AND RESULTS: QOL measurements were collected before and 6 months after ICU admission. Comorbidity classified by the Charlson index was 2.44 +/- 1.96. Mean stay in the ICU was 10.4 +/- 15.1 days, mean Acute Physiology and Chronic Health Evaluation II score was 23 +/- 10. Cumulative mortality was: ICU 24 %, hospital 34 %, 6 months 43 %. Relative to baseline, follow-up interviews of 185 survivors revealed no significant changes in the overall QOL score (p = 0.93). The subscales basic physiological activities (p = 0.07) and normal daily activities (p = 0.15) showed a nonsignificant deterioration. A significant improvement was noted for the domain emotional state (p = 0.013). CONCLUSIONS: Six months after admission to a medical ICU most survivors had regained their preadmission health-related QOL. Multivariate analysis showed that preadmission QOL, age, and severity of illness were most strongly associated with follow-up QOL. Of the survivors 86 % were living at home, and all but one of those previously in employment had returned to their former work. Most patients (94%) would undergo ICU treatment again if necessary.     

Physicochemical characterization of a model intravenous oil-in-water emulsion.

Photon correlation spectroscopy, nuclear magnetic resonance spectroscopy, electron microscopy, and small-angle X-ray scattering were used for the structural characterization of a model oil-in-water emulsion containing particles in the submicrometer size range. Additionally, small-angle X-ray diffraction, wide-angle X-ray diffraction, and differential scanning calorimetry were applied to raw materials and to binary mixtures. The majority of emulsion droplets have the characteristic of an ideal emulsion droplet, that is, a liquid lipid core covered by an emulsifier monolayer. However, the system contains a certain excess of emulsifier. Particles with bi- and/or oligolayer structures can be deduced. Double-emulsion droplets were detected. Large unilamellar vesicles were not found; however, the existence of small unilamellar liposomes (also referred to as small unilamellar vesicles or SUVs) seems likely. The proportion of all small nonmonolayer structures was quantified by nuclear magnetic resonance spectroscopy. No mixed micellar structures were detectable. Lysophospholipids were not detected in the aqueous phase, indicating their predominant incorporation into the emulsifier layers. Water-soluble phospholipid degradation products were found in the water phase. The existence of at least several monolayers of phospholipids does not seem to be a prerequisite for a stable soybean oil-in-water emulsion, in general.     

Intellectual functioning in lobotomized and non-lobotomized long term chronic schizophrenic patients

Administered the WAIS routinely to 28 long term hospitalized chronic schizophrenic patients who had a bilateral prefrontal lobotomy during the years between 1948 and 1954 and 28 of their non-lobotomized counterparts matched on appropriate demographic characteristics. No statistically significant t-score differences between group means were demonstrated on any of the 11 subtests or three scale IQs.